SITE APPLICATION

Please be sure that ALL of the requested information below is provided. ANew Install Application Fee of $1,500.00 or $1,000 Additional Equipment Application Feeis required to accompany this form for consideration. Please do not hesitate to call us if you have any questions regarding this application.
WichitaTowers Site ID & Name: / Applicant Site ID Name:
Desired In Service Date: / Site Status: Built Not Built (Click to Check One)
Purpose of System (Click & Select): CellularPagingInternet2-WayEmergencyGovernmentOther ______/ Structure Type (Click & Select): MonopoleSelf SupportGuyedLatticeRoof TopWater TowerOther ______

SITE INFORMATION

Please refer to or call 316-219-8557
Street Address:
City: / State: / ZIP:
Latitudes (NAD 83): / -- . W / Longitudes (NAD 83): -- . N

POINT OF CONTACT INFORMATION

This information may include contractor or site acquisition consulting information. Please include information for the initial point of contact – this person will be contacted for any issues prior to an executed lease.
Company Name:
Point of Contact:
Street Address:
City: / State: / ZIP: / -
Phone Number: / . . x / Fax Number: / . . x
E-mail Address:

APPLICANT INFORMATION

This information should not include contractor or site acquisition consulting information. Please include only carrier specific information as it pertains to the leasing process.
Company Name:
Point of Contact:
Federal Tax No.:
Street Address:
City: / State: / ZIP: / -
Phone Number: / . . x / Fax Number: / . .
E-mail Address:
Contract to Be Executed By:
Accounts Payable Contact (Sublease Level):
Are You a Corporation or Partnership?
State in Which Your Business Entity was Formed:
Company Name & Address to Appear on Legal Documents for Notice provision: / Name:
Address:

RF ENGINEERING INFORMATION

(All information must be completed, and should include contacts for construction and post-construction phases.)
RF Contact:
Phone Number: / . . x / E-mail Address:
Construction Contact:
Phone Number: / . . x / E-mail Address:
Network Ops. Contact:
Phone Number: / . . x / E-mail Address:

TECHNICAL PARAMETERS

***Please attach antenna specification sheets*** Please place additional equipment information on the next page.
ALPHA / BETA / GAMMA
Antenna Quantity
Azimuth Orientation (Deg)
Antenna Manufacturer & Model #
Antenna Dimensions (l x w x d / wt)
Antenna Mounting Type
Downtilt Mechanical Elec
TX/RX or Duplexed?
Proposed AntennaCenter Line
Trans Line Type/Size
Total Number of Lines per Sector
Total # TMAs/MHAs per Sector
Power Output
Frequency (MHz and Band Type)

BASE STATION EQUIPMENT

Equipment Type:
Manufacturer: / Model Type:
FCC Type Acceptance Number:
Power Output (Watts):
Is a waveguide truss/cover plate needed from the tower to your equipment space? Yes No (Click to Check)

POWER REQUIREMENTS

Required Voltage & Total Amperage:
Are you providing your own generator back up power? Yes No (Click to Check)
Space required for generator: / Is an additional fuel tank needed?

LAND REQUIREMENTS

How large a parcel or land is required? / Length (ft): / Width (ft):
Will an external shelter be required? Yes No (Click to Check)
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/ wichita towers site application.doc / Fax: 316.219.8600